Corneal degeneration refers to degenerative changes in the normal cells of the cornea under the influence of age or pathology. There are various types classified by location (axial or peripheral) or etiology (age-related or pathological). Common age-related degenerations include arcus senilis, Vogt's white limbal girdle, and Hassal-Henle bodies. Pathological degenerations comprise fatty degeneration, amyloidosis, calcific/band keratopathy, Salzmann's nodular degeneration, and pellucid marginal degeneration. Treatment options include phototherapeutic keratectomy, corneal transplantation, or superficial keratectomy depending on the type and severity of degeneration.

1. CORNEAL
DEGENERATION
By- Shweta Santosh Maurya
2nd year B. Optometry
Institute For Technology And Management

2. WHAT IS CORNEAL DEGENERATION
 corneal degeneration refers to the condition
in which the normal cells undergo some
degenerative changes under the influence
of age or some pathological condition.

3. CLASSIFICATIONS
 A. Depending upon locations
I. Axial corneal degeneration
1. Fatty degeneration
2. Hyaline degeneration
3. Amyloidosis
4. Calcific degeneration(Band keratopathy)
5. Salzmann’s nodular degeneration

4. II. PERIPHERAL DEGENERATION
1. Arcus senilis
2. Vogt’s white limbal girdle
3. Hassa-Henle bodies
4. Terrien’s marginal degeneration
5. Morren’s ulcer
6. pellucid marginal degeneration
7. Furrow degeneration(senile marginal
degeneration)

5. B. DEPENDING UPON ETIOLOGY
A] Age related degeneration:-
Arcus senilis, Vogt’s white limbal girdle,
Hassal-Henle bodies,Mosaic degeneration.
B] Pathological degeneration:-
Fatty degeneration, Amyloidosis, Calcific
degeneration, Salzmann’s degeneration,
Furrow degeneration, Spheroid
degeneration, Pellucid marginal
degeneration, Terrien’s marginal
degeneration

6. AGE RELATED CORNEAL
DEGENERATIONS

7. ARCUS SENILIS
 Arcus senilis refers to
an annular lipid
infiltration of corneal
periphery.
 Sometimes, similarly
changes may or may
not be associated
with hyperlipidemia.

8. CLINICAL FEATURES
 The arcus starts in the
superior and inferior
quadrants and then
progresses
circumferentially to form
a ring which is about 1
mm wide.
 Peripheral border of this
ring opacity is sharp
while central border is
diffuse
 This ring of opacity is
separated from the
limbus by a clear zone.

9. VOGT’S WHITE LIMBAL GRIDLE
 It appears as bilaterally
chalky white opacities in
the interpalpebral area
both nasally and
temporally .
 Here may or may not be a
clear between opacity and
the limbus.
 The opacity is at the level
of Bowman’s membrane .

10. HASSAL-HENLE BODIES
 Hassal-henle bodies are
drop like excrescences of
hyaline materal projectng
into the anterior chamber
around the corneal
periphery.
 These form the
commonest senile change
seen in the cornea.
 In pathological conditions
they become larger and
invade the central area and
the condition is called
CORNEAL GUTTATA

11. • Tiny dark
spots on
central
endothelium
• Similar
peripheral
lesions are
Hassell-Henle
bodies

12. PATHOLOGICAL CORNEAL DEGENERATION

13. FATTY DEGENERATIONS
 It is characterized by
whitish or yellowish
deposits.
 Initially fat deposits are
intracellular but some
becomes extracellular
with necrosis of stromal
cells.
 Lipid keratopathy can be
primary or secondary

14. TREATMENT
 Treatment is usually unsatisfactory
 In some cases slow resorption of lipid
infiltrate can be induced by argon laser
photocoagulation of the new blood vessels.

15. HYALINE DEGENERATION
 Primary Hyaline
degeneration association
with granular dystrophy .
 Secondary Hyaline
degeneration is unilateral and
associated with various types
of corneal disease including
old keratitis, long-standing
Glaucoma, trachomatous
pannus.
 It may be complicated by
recurrent corneal erosion.

16. TREATMENT
 Treatment of the condition when it causes
visual disturbance is keratoplasty

17. AMYLOID DEGENERATION
 Amyloid degeneration of
cornea is characterized
by deposition of Amyloid
material underneath
epithelium.
 It is very rare condition
and occurs in primary
(in a healthy cornea)
and secondary forms (in
a disease cornea).

18. CALCIFIC DEGENERATION
(BAND SHAPE KERATOPATHY )
 Band shape
keratopathy (BSK) is
essentially a
degenerative change
associated with
deposition of calcium
salts in Bowman’s
membrane, most
superficial part of
stroma and in deeper
layers of epithelium.
Band shape keratopathy Calcific degeneration (BSK)

19. ETIOLOGY
 Ocular disease complicated by band keratopathy
include chronic uveitis in adults, children with
still’s disease, phthisis bulbi, chronic Glaucoma,
chronic keratitis and ocular trauma.
 Age related BSK is common and affects
otherwise healthy cornea.
 Metabolic conditions rarely associate with BSK
included hypercalcaemia

20. CLINICAL FEATURES
 It typically presents as
a band shaped opacity
In the interpalpebral
zone with a clear
interval between the
ends of the band and
the limbus.
 The condition begins
at the periphery and
gradually progresses
towards the centre.

21. TREATMENT
 Chemical removal of calcium salts - EDTA
 Phototherapeutic keratectomy(PTK)
 Keratoplasty.

22. SALZMANN’S NODULAR DEGENERATION
 Salzmann’s nodular
degeneration SND is a
slowly progressive
condition in which gray-
white to bluish nodules
measuring 1-3 mm are
seen anterior to
Bowman’s layer of the
cornea.
 They are classically
round and located in
the mid-peripher.
SND is classically round and
located in the mid-peripher

23. PATHOGENESIS
 In Salzmann's nodular degeneration raised
hyaline plaque are deposited between
epithelium and bowman’s membrane
 There is associated destruction of
bowman’s membrane and the adjacent
stroma

24. ETIOLOGY
 This condition occurs in eye with recurrent
attacks of phlyctenular keratitis, rosacea
keratitis and trachoma
 The condition occurs more commonly in
women and is usually unilateral

25. CLINICAL FEATURES
 Patient may experience discomfort due to
loss of epithelium from the surface of the
nodules impinge on the central zone.

26. TREATMENT
 To improve visual acuity and to decrease
the irregular astigmatism a superficial
keratectomy was recommended to remove
the Salzmann’s nodules.
 Treatment is essential by keratoplasty

27. CLINICAL FEATURES
 About 75% of affected patients are usually
male
 Mostly involves superior peripheral cornea

28. TERRIEN’S MARGINAL DEGENERATION
 Terrien’s Marginal
Degeneration is
non-ulcerative
thinning of the
marginal cornea.

29. COMPLICATION
Complication such as perforation (due to
mild trauma) and pseudopterygium may
develop.

30. ETIOLOGY
 It typically occurs in men who work out-
doors epically in hostile climate.
 Its occurrence has been related to exposure
to ultraviolet rays and /or ageing and/or
corneal disease.

31. TREATMENT
Early refractive treatment includes:
 spectacles (polycarbonate),
 CL an option though difficult to fit due
to irregular astigmatism (RGP over
piggyback),
 And when vision uncorrectable surgical
intervention includes PK.

32. SPHEROID DEGENERATION
 This relatively
common condition
features characteristic
oil deposits at the
limbus which are
characterized
histologically as
mauve globular
degeneration and are
strongly associated
with UV exposure.

33. CLINICAL FINDINGS
 0.1-0.6 mm yellow oil
droplets deposit near the
limbus in the 3 and 9
o’clock positions in older
individuals.
 The areas may appear
band shaped and often are
associated with
pingueculae but
presumably and
incredulously not pterygia!

34. CLINICAL FEATURES
 In this condition amber-coloured spheroidal
granules accumulate at the level of
bowman’s membrane and anterior stroma in
the interpalpebral zone.
 In marked degeneration the vision is
affected

35. TREATMENT
 Treatment in advance cases is by corneal
transplantation

36. PELLUCID MARGINAL CORNEAL
DEGENERATION
 Acute hydrops maybe seen in the area of
inferior thinning.
 Commonly manifests b/w ages of 20-40 with
no apparent hereditary transmission and
equal gender distribution

37. PELLUCID MARGINAL CORNEAL
DEGENERATION

38. SIGNS
 Inferior corneal thinning
 Severely reduced uncorrected visual acuity
that typically cannot be improved with
spherocylinder lens
 Practically normal pinhole visual acuity

39. DIAGNOSTIC PROCEDURES
 Corneal topography
 Pachymetry: Used to measure for inferior
corneal thinning, which is a reversal of the
typical pattern in which the cornea thickens
from centre to periphery
 Orbscan: Shows a classic "kissing birds"
appearance with PMD

40. TREATMENT
 Because of extremely abnormal corneal
topography, the treatment of PMD is difficult.
 Therapeutic options are limited by the
degree of corneal protrusion.
 A recent study has found that 88% of PMD
cases were managed nonsurgically with
spectacles (36%) or contacts (52%),
whereas 12% underwent penetrating
keratoplasty.

41. PELLUCID MARGINAL DEGENERATION

42. MOOREN'S ULCER
 There is (but may be
bilateral in younger
patient) peripheral
ulcerative keratitis
located in the
interpalpebral region.
 The ulceration is
contiguous with the
limbus without
intervening clear zone.
 The epithelium is
vascularized and there is
an overhanging
advancing edge.

43.  THANK YOU 